This project studies the expression of rheumatic diseases in an underserved, largely ethnic minority community in the Washington, DC metropolitan area. Through the NIAMS Community Health Center, subjects with rheumatic compliants are evaluated and provide researchers with first-hand experience in understanding barriers to care. This project has supported research on cultural differences in understanding standardized self-report outcome assessment tools, use of complementary and alternative medicine in patients with rheumatic symptoms, understanding of the research process and informed consent among ethnic minorities, and validation in Spanish and English of a rheumatoid arthritis case-finding questionnaire for use in epidemiological studies. In addition, researchers have examined interventions to improve the referral process between primary care providers and subspecialists.